Question Pertaining to Disciplinary Actions Do any of the pharmacy owners have a direct or indirect ownership interest in any other pharmacy?.Is your pharmacy directly or indirectly affiliated with any other pharmacies?.Questions Pertaining to Affiliated Pharmacies

Does your pharmacy contract with or employ a sales force? If yes, describe the activities of the sales force.Does your pharmacy ever waive or offer a reduction of member copayments? If yes, provide a copy of your written policy relating to the waiver/reduction of copayments.Indicate the percentage income derived from: Medicaid, Medicare, Workers Comp, 340B, Compounds, and Dispensing Physician.Is your pharmacy registered/affiliated with a compounding supplier?.Does your pharmacy participate in complex compounding?.Indicate the percentage of Rx volume in each of the following settings: Open Door/Retail/Community, Closed Door/Clinic Facility, Mail Order, Nursing Home/LTC, Internet Pharmacy, and Other.Is 25% or more of your pharmacy business mail order?.Recredentialing Questionnaire: Examples of Questions and Certification Recredentialing questionnaires inquire about a number of issues, including whether the pharmacy is engaged in mail order or compounding whether the pharmacy’s marketing reps are W2 employees or 1099 independent contractors and the collection of copayments. They will recredential pharmacies every year or couple of years to ensure they meet the PBMs’ participation requirements.

PBMs validate the credentials of pharmacies to ensure they are in good standing with state and federal laws and meet quality performance standards. If the PBM simply 'does not like what the pharmacy is doing,' then the PBM can terminate the contract.

'Without cause' means exactly what it says. 'With cause' can include misrepresentations by the pharmacy to the PBM, such as answers in a recredentialing questionnaire failure by the pharmacy to adhere to the requirements imposed by the PBM on its member pharmacies, and a breach by the pharmacy of terms of the PBM contract. At the end of the day, the PBM 'possesses the pharmacy’s money.' Most, if not all, PBM contracts give the PBM the right to terminate its contract with the pharmacy with, or without, cause. There is an old saying, 'Possession is 9/10ths of the law,' and that applies to PBMs. A PBM acts as a fiscal intermediary between insurers/payors and pharmacies. A Pharmacy Benefit Manager (PBM) is a third party administrator contracted by health plans, employers, unions and government entities to manage prescription drug programs.

Discovery pro pbm contact number